1437402484 NPI number — MR. ROBERT WESLEY TINKLEPAUGH II

Table of content: MR. ROBERT WESLEY TINKLEPAUGH II (NPI 1437402484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437402484 NPI number — MR. ROBERT WESLEY TINKLEPAUGH II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TINKLEPAUGH
Provider First Name:
ROBERT
Provider Middle Name:
WESLEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437402484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4769 LOWER RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14092-1038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-609-1502
Provider Business Mailing Address Fax Number:
866-910-3896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4769 LOWER RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14092-1038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-609-1502
Provider Business Practice Location Address Fax Number:
866-910-3896
Provider Enumeration Date:
10/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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